Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
4400 NE HALSEY ST, BLDG 2, STE 599, PORTLAND, OR 97213-1545
(503) 215-3300
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Enumeration date
04/06/2023
Last updated
07/04/2025
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